Road traffic injuries in Poland: magnitude and risk factors

Abstract

Introduction
The article presents the epidemiology of road traffic injuries and fatalities in Poland in the years 2004–2014. In Poland, every fourth death caused by external reasons is the result of a road traffic crash and Poland has one of the highest road fatality rates in relation to vehicle ownership in Europe, with an average 23 deaths per million residents. This rate is two times higher than most other European Union countries.

Materials and methods
The research is based on a secondary analysis of data contained in multiple Polish governmental reports, including those of the Prevention and Analysis Office of Road Traffic Headquarters of Police, National Road Safety Program—GAMBIT 2005, National Road Safety Program 2013 to 2020, and Strategy for Efficient State in 2020, plus previous publications describing road safety in Poland. Data were analysed in two steps. First, the data were described using means and frequencies, and tabulated according to variables. Second, we considered the time frame (day, month, and year of the occurrence), the place and the circumstances of fatal road crashes, the kind of event, and types of road crashes.

Results
Between 2004 and 2014, there were 475,591 traffic crashes on Polish roads. 52,217 people were killed and 597,191 people were injured. Traffic-related injuries represent the leading cause of death for Polish men up to 44 years of age. The most common cause of road crashes in Poland was failure to comply with the rules of the road traffic, such as through excessive speeding. We also found drivers poorly assessed road situations, faced a lack of adequate road infrastructure, and maintained many vehicles in poor condition.

Discussion
Despite the variety of measures undertaken to improve safety on Polish roads, including modifications of the law as well as improving road quality, the number of fatalities and injuries resulting from motor vehicle crashes is still considerable, and the losses incurred by Polish society are still substantial.

Conclusions
The number of fatalities and injuries as a result of road crashes in Poland remains very high. Multifaceted action to improve safety on the roads in Poland should continue.

Full text

Vol.:(0123456789)
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European Journal of Trauma and Emergency Surgery
https://doi.org/10.1007/s00068-019-01093-6
REVIEW ARTICLE
Road traffic injuries inPoland: magnitude andrisk factors
WitoldPawłowski1 · KrzysztofGoniewicz2· DavidC.Schwebel3· JiabinShen4· MariuszGoniewicz5
Received: 23 December 2018 / Accepted: 7 February 2019
© Springer-Verlag GmbH Germany, part of Springer Nature 2019
Abstract
Introduction The article presents the epidemiology of road traffic injuries and fatalities in Poland in the years 2004–2014.
In Poland, every fourth death caused by external reasons is the result of a road traffic crash and Poland has one of the highest
road fatality rates in relation to vehicle ownership in Europe, with an average 23 deaths per million residents. This rate is
two times higher than most other European Union countries.
Materials and methods The research is based on a secondary analysis of data contained in multiple Polish governmental
reports, including those of the Prevention and Analysis Office of Road Traffic Headquarters of Police, National Road Safety
Program—GAMBIT 2005, National Road Safety Program 2013 to 2020, and Strategy for Efficient State in 2020, plus pre-
vious publications describing road safety in Poland. Data were analysed in two steps. First, the data were described using
means and frequencies, and tabulated according to variables. Second, we considered the time frame (day, month, and year
of the occurrence), the place and the circumstances of fatal road crashes, the kind of event, and types of road crashes.
Results Between 2004 and 2014, there were 475,591 traffic crashes on Polish roads. 52,217 people were killed and 597,191
people were injured. Traffic-related injuries represent the leading cause of death for Polish men up to 44years of age. The
most common cause of road crashes in Poland was failure to comply with the rules of the road traffic, such as through
excessive speeding. We also found drivers poorly assessed road situations, faced a lack of adequate road infrastructure, and
maintained many vehicles in poor condition.
Discussion Despite the variety of measures undertaken to improve safety on Polish roads, including modifications of the law
as well as improving road quality, the number of fatalities and injuries resulting from motor vehicle crashes is still consider-
able, and the losses incurred by Polish society are still substantial.
Conclusions The number of fatalities and injuries as a result of road crashes in Poland remains very high. Multifaceted action
to improve safety on the roads in Poland should continue.
Keywords Road traffic safety· Mortality rates· Injury rates· Vehicle speeding· Traffic violations
Introduction
Road traffic injuries are a significant public health and
social problem globally. According to the World Health
Organization (WHO), 1.3million people are killed annu-
ally on the roads worldwide, and 20–50million people
Electronic supplementary material The online version of this
article (https ://doi.org/10.1007/s0006 8-019-01093 -6) contains
supplementary material, which is available to authorized users.
* Krzysztof Goniewicz
k.goniewicz@law.mil.pl
Witold Pawłowski
witold.pawlowskl@dr.com
1 Department ofDisaster Medicine, Medical University
ofWarsaw, Warsaw, Poland
2 Department ofSecurity Studies, Polish Air Force Academy,
Dywizjonu 303 street, no 35, Dęblin08-521, Poland
3 Department ofPsychology, University ofAlabama
atBirmingham, Birmingham, USA
4 Center forInjury Research andPolicy, Research Institute
atNationwide Children’s Hospital, Columbus, USA
5 Department ofEmergency Medicine, Medical University
ofLublin, Lublin, Poland

W.Pawłowski et al.
1 3
suffer severe injuries that require long-term and expensive
treatment. Without efforts to improve road safety, the num-
ber of people killed and injured as a result of motor vehicle
crashes (MVC) will increase by about 65% over the next
20years. In fact, WHO projects that by 2030, MVC will
become the fifth leading cause of death, causing 3.6% of
all deaths worldwide [1, 2].
Poland has one of the highest road fatality rates in rela-
tion to vehicle ownership in Europe, with an average 23
deaths per million residents, a rate two times higher than
the rate in most other European Union (EU) countries [3].
Road traffic crashes are the fourth leading cause of death in
Poland, presenting a major public health problem in terms
of morbidity, disability and associated health care costs
[4]. Road safety measures currently in place are ineffec-
tive [3, 5]. Specifically, the Polish government has taken
measures to improve safety on Polish roads, including
attempts to educate road users about safety, enforce and
punish drivers for breaking laws of the road, implement
new regulations concerning the technical condition of
vehicles, and update the roads for safety [6]. Despite this,
the number of injuries and fatalities, and casualties that
occur as a result of MVC in Poland remains considerable.
The most comprehensive published reports on motor
vehicle crashes in Poland are from two sources, three of
them published in Polish [6, 7] and the other, more recent
report, published in both Polish and English in a minor
Polish journal [8]. Between 1980 and 2014, the number of
road crashes in Poland has oscillated substantially. Notable
changes occurred at a few time points. Between 1988 and
1991, a period of significant political change in Poland,
crash rates grew substantially. In 1990, the number of
crashes exceeded 50,000 for the first time, reaching a 1991
peak of 54,000 [7]. After a slight decline, a second peak
occurred in 1997, when the rate exceeded 66,000. From
1998 to 2015, crash rates decreased (with a slight retreat
in 2007 and 2008), likely a result of Poland’s admittance
into the European Union and the policies put in place as a
result of that membership.
Road traffic injuries also pose significant financial bur-
dens to Polish society. World Bank experts estimate that
the annual cost of fatal traffic crashes in Poland is nearly
11billion Polish zloty ($3billion US dollars) and that
the cost of all the consequences of motor vehicle crashes
in Poland crashes is between 27 and 34billion zloty
($7.3–9.2billion US dollars).
The present paper presents a situational analysis of the
problem and highlights some impediments to intervention.
The aim of this study was to analyse patterns in recorded
fatalities from MVC over the period from 2004 to 2014, as
well as factors within the Polish traffic context connected
to the environment that may lead to crashes.
Materials andmethods
Sources ofdata
This study was conducted in Poland, an Eastern European
country with 38 479k inhabitants in 2014. To conduct our
research, we merged secondary data and information from
the following five sources, all of which were prepared by
official government sources. The first two sources provided
raw data and the last three provided tables, information,
and ideas relevant to our research:
1. Annual reports from the Prevention and Analysis Office
of the Road Traffic Headquarters of Police, 2004–2014
(http://www.polic ja.pl). These reports outline the prob-
lems related to road safety in Poland. They list general
data on MVC in Poland, including risk factors, and the
rate of road crashes in particular months of the year,
days of the week, times of the day and the types of areas
where crashes took place (urban or non-urban). Crashes
were included if they were handled by police in any Pol-
ish jurisdiction.
2. Data from the Central Statistical Office of Poland
(http://www.stat.gov.pl) These data came from hospitals
nationwide and were used to corroborate and supple-
ment reports from the Police reports. All injuries severe
enough to require inpatient treatment (hospitalization)
in a Polish hospital were included in the database. Some
injuries that were severe but did not require hospitaliza-
tion (e.g., were treated on an outpatient basis) were also
included.
3. National Road Safety Program—GAMBIT 2005 (http://
www.krbrd .gov.pl), which includes lists of safety solu-
tions that were implemented in Poland and those that
need to be implemented, solutions that succeeded and
solutions that failed, plus offers advice on how to over-
come failures. European requirements are enumerated in
the document and address the situation on Polish road-
ways.
4. National Road Safety Program 2013–2020 (http://www.
krbrd .gov.pl), which focuses on the general diagnosis
of road safety on Polish roads. This document consid-
ers international perspectives and offers data on safety
limitations present on Polish roadways.
5. Strategy for Efficient State in 2020 (http://www.admin
istra cja.mswia .gov.pl), which includes data and infor-
mation concerning how to increase the efficiency of
transport to facilitate traffic efficiency in urban areas.
According to the document, the system of fund manage-
ment for transport in Poland is in need of modification;
the document offers data on potential modifications to

Road traffic injuries inPoland: magnitude andrisk factors
1 3
the funding system and how those modifications might
improve the Polish transportation infrastructure.
We used the five data sources in conjunction with each
other for two reasons. First, the data did not overlap entirely,
so we merged data sources to obtain the most complete
data possible about traffic crashes, injuries and mortalities
in Poland. Second, the information was released at differ-
ent time points by different agencies and we used the first
(or sometimes only) available data to answer our questions
of interest. In cases when information to answer our study
hypotheses was available from two data sources (e.g., raw
data from the annual police reports and the hospital/medi-
cal data) and did not match, we consulted with the primary
statistical office in the Polish government, which collected
the evidence and offered an official decision to resolve dis-
crepancies. Because all information sources were secondary
and the researchers did not have access to identifying data,
the research was exempted from review by our university’s
ethical committee.
Method ofanalysis
Data were analysed in two steps. First, the data were
described using means and frequencies and tabulated
according to variables. Second, we considered the time
frame (day, month, and year of the occurrence); the place
and the circumstances of crashes, the kind of event, and
types of road crashes.
Results
The number ofroad traffic crashes inPoland,
2004–2014
Between 2004 and 2014, there were 475,591 road crashes on
Polish roads. 50,217 people were killed and 597,191 people
were injured in those crashes [7]. In 2010, the last year of the
implementation of the European Road Safety Programme,
the number of road fatalities in Poland for the first time fell
below 4000. It also represented the third year in a row with
a downward trend concerning both the number of crashes
and the people injured or killed (Table1).
There also have been substantial decreases in the number
of fatalities per crash over time, and in the number of fatali-
ties among those who were injured (Table1). Both figures
consistently decreased between 2004 and 2014. Despite
these promising data, the number of fatal road crashes
remains high in Poland compared to other European coun-
tries. Polish mortality rates are almost three times higher
than in the Netherlands and 2.5 higher than in Sweden and
Great Britain. The rate of traffic fatalities and injuries in
Poland also is decreasing more slowly than in other Euro-
pean countries. From 2001 to 2010, the number of road fatal-
ities decreased by 29% in Poland and the number of injuries
decreased by 28%. These were among the smallest declines
among the Member States of the European Union [4, 9–11].
The months anddays road crashes occur
Between 2004 and 2014, Polish road crashes occurred most
often in October, July and August (Fig.1), and least often
in January and February [4]. The large number of crashes
in summer and autumn coincide with increased traffic dur-
ing holidays and the deterioration of road conditions with
poor weather in autumn. These months also have the highest
number of fatalities and injuries (Supplementary Appendix
Table1).
There was a trend for declining motor vehicle crashes
over the study period. The positive change is also present,
although somewhat less as distinct, when considering the
Table 1 Road crashes and their consequences in Poland in the years
2004–2014
Year Crashes Deaths Injuries Fatali-
ties/100
crashes
Fatali-
ties/100
injuries
2004 51,069 5712 64,661 15 11
2005 48,100 5444 61,191 14 11
2006 46,876 5243 59,123 14 11
2007 49,536 5583 63,224 15 11
2008 49,054 5437 62,097 14 11
2009 44,196 4572 56,046 12 10
2010 38,832 3907 48,952 10 10
2011 40,065 4189 49,501 10 11
2012 37,046 3571 45,792 9 9
2013 35,847 3357 44,059 9 8
2014 34,970 3202 42,545 9 8
Total 475,591 50,217 597,191
Fig. 1 Road crashes in Poland by month (2004–2014)

W.Pawłowski et al.
1 3
number of crashes on particular days of the week (Supple-
mentary Appendix Table2). There was a drop of about 1000
crashes on each day between year 2004 and 2014.
More broadly, analysing the incidence of road crashes
by the day of the week (Fig.2), we found that crashes were
most common on Fridays and most fatal on Saturdays. Sup-
plementary Appendix Table2 provides additional data on
the number of road injuries across the days of the week.
Between 2004 and 2014, the highest number of traffic
crashes occurred between 2 p.m. and 7 p.m., and especially
between 4 p.m. and 6 p.m. This coincides with the period of
heaviest traffic as people return home after work. The fewest
crashes occurred between 12 midnight and 5 a.m.
Location ofroad crashes
As shown in Fig.3, the majority of road crashes occurred
in urban areas (72%; see also Supplementary Appendix
Table3). Crashes were most common on straight roads
(60%); crashes on straight roads also resulted in the largest
number of fatalities and injuries. Other dangerous locations
were intersections (20% of crashes), and sharp curves and
bends (10% of crashes).
Types ofroad crashes
The dominant type of road crashes in Poland since the 1990s
has been “collisions between vehicles in motion”, which
includes frontal impact, side impact, and rear-end crashes.
They accounted for 51% of the total number of crashes. The
next most common type of crash was “hitting a pedestrian”
(26%). The most fatalities, resulting in over 30% of those
killed, were a result of “hitting a pedestrian” [7, 12]. Com-
pared to other EU countries, the proportion of pedestrian
crashes and fatalities in Poland is very high [2].
Casualties byroad user type
The majority of road crashes in Poland between 2004 and
2014 occurred due to fault of the driver (79%), with the
remaining crashes attributed to the fault of pedestrians
(15%), passengers (0.2%) complicity of road traffic partici-
pants, (0.9%) and other reasons (5.1%) [5, 7].
The main causes of crashes caused by drivers were inap-
propriate speed for the traffic conditions, failure to comply
with the right of way, improper conduct toward pedestrians
(improper maneuvering through pedestrian crossings and
not giving way to pedestrians), failure to keep a safe distance
between vehicles, incorrect overtaking, improper turning,
driving on the wrong side of the road, improper circumven-
tion, improper reversing, improper lane changes, fatigue and
falling asleep [7, 13].
The frequency of drivers disregarding existing speed lim-
its in Poland is supported by previous research, which shows
that on average 45% of drivers have a tendency to exceed
legal speeds, especially on national roads. Crashes resulting
from speeding were severe and resulted in numerous fatali-
ties (approximately 30% of all deaths) [7].
We also considered the gender and age of drivers involved
in crashes. Between 2004 and 2014, the most common per-
petrators of road crashes in Poland (82%) were men [4,
5]. From 2006 to 2014, around 20million people living in
Poland had a driving license, with women constituting 44%
of those individuals. Thus, men were disproportionately
involved in crashes compared to women, although there is
some evidence that female licensed drivers in Poland drive
less often compared to male drivers [6–8]. Previous research
also suggests that men are more prone to excess speed, risky
behaviour, alcohol-impaired driving, and less regard for the
traffic rules [7, 14].
In the years 2004–2014, the largest number of vehicle
drivers causing crashes in Poland was in the 25–39-year-
old group. Young drivers aged 18–24 caused a high rate of
crashes also, including about 25% of crashes resulting from
the fault of drivers [6, 7, 13, 15].
The threat to vulnerable road users (pedestrians, cyclists,
motorcyclists) occurs in all countries. In Poland, this
Fig. 2 Road crashes and fatality by day of the week (2014)
Fig. 3 Road crashes between urban and non-built-up areas (2004–
2014)

Road traffic injuries inPoland: magnitude andrisk factors
1 3
phenomenon is particularly troublesome. On Polish roads,
on average every 24min a pedestrian loses his/her life or
suffers a bodily injury. Crashes involving pedestrians rep-
resent almost 40% of all traffic crashes in Poland, a sharp
contrast to data from other European Union countries where
pedestrian crashes account for between 8% and 19% of total
crashes [4, 6, 10, 16, 17].
Discussion
Worldwide, traffic crashes claim more deaths than war, and
millions of survivors are handicapped from them [9–12].
Social and economic impacts of traffic crashes and their
consequences are severe. Additionally, the costs of traffic
crashes have a significant impact on global economies, par-
ticularly in low- and middle-income countries that struggle
also with other development needs. In Poland, the costs of
road traffic crashes equal 2.1% of gross domestic product
[9, 10, 17–19].
Our results indicate motor vehicle crashes in Poland
decreased between 2004 and 2014: the total number of traf-
fic crashes dropped by more than 15,000 and the number of
fatalities decreased nearly in 50% over the 10-year period.
The reasons behind the drop might be attributed to two pri-
mary factors: (a) technical improvements in the roads, the
result of major investments made with EU funds; and (b)
traffic laws that were implemented to punish reckless drivers.
In July 2010, the European Commission adopted a plan
aiming to reduce the number of fatalities on Europe’s roads
by half over the subsequent 10 years [20, 21]. Poland’s pro-
gress on this plan between 2004 and 2014 is mixed. There
was a clear decline in the number of crashes, injuries and
mortality rates over the time period, a promising sign. How-
ever, Poland greatly lags EU endeavors to limit MVC fatali-
ties. In the time period of our study, the number of fatalities
on Polish roads decreased by only 29%, a decline that trailed
all European nations except Romania, Malta and Bulgaria.
In 2011, 109 fatalities per 1million residents of Poland were
recorded, the highest rate in the EU. Thus, driving on Polish
roads continues to represent risk that is higher than most
other European countries [22, 23].
There are several possible reasons for the risks that
remain in Poland [2, 7]. First, infrastructure development
issues place a strain on Polish roads. The poor condition
of the Polish road network was recognised as having a
detrimental effect on Poland’s high rate of MVC [15–17],
and there are currently many projects to build motorways
underway, including construction of A1 (318.6km out of
565.1km to be completed as of 2021), A2 (469.9km out
of 622.6km currently completed), and A4 (512km out of
670km planned) [16, 17].
Second, Poland has an extremely high rate of pedes-
trian injuries. More than 1/3 of pedestrians killed in Poland
were struck at night on unlit roads. Poland has one of the
lower urbanization coefficients in the EU, a factor that
could explain high casualty rates on unlit roads as well as
greater pedestrian mortality in general. A related concern
is the location of pedestrian crossings in Poland. In many
cases, crossings are placed just around the corner from turns,
diminishing the ability for drivers to notice and respond to
pedestrians on the roadway [7]. Legal protection of pedes-
trians in Poland begins only after pedestrians enter the
roadway, whereas in most European countries legal protec-
tion initiates when pedestrians are in the proximity of the
roadway. Finally, some have argued the Polish Police do not
investigate details of crashes involving pedestrian fatalities
adequately [4]. Polish Police statistics from 2008, 2009, and
2010 suggest 33% of crashes with pedestrian casualties were
the fault of the surviving pedestrian, whereas 54% of crashes
with pedestrian fatalities were the fault of the pedestrian.
The noticeable difference has been questioned. A third factor
in the high rate of MVC in Poland is the careless and risky
driving displayed in the country. Efforts to change these
culturally-based habits may be difficult but worthwhile [4].
Implications forprevention
To improve road safety in Poland, we must consistently
implement tasks designed to educate and motivate society
toward the desired behavioural change, thus improving traf-
fic safety. We must strengthen social awareness of punish-
ments for failure to comply with road traffic regulations,
including excessive speeding and intoxicated road use, and
enforce those policies [6, 13, 15]. Moreover, we should
improve road infrastructure, eliminate hazardous locations,
and properly design the road system to protect all road users,
including vulnerable road users such as pedestrians who
suffer injury and mortality at elevated rates in Poland. We
should also remove vehicles in poor condition from the road-
ways, organise first aid training to the public, and improve
emergency response to serious crashes [24].
The cold and wet climate in Poland introduces challenges
that are not present in many other countries. Measures rec-
ommended to reduce crashes caused by wet, muddy or icy
roads include improved winter maintenance, communication
systems to inform drivers about road-related weather and
conditions, driver education, road surveillance and traffic
control. Snow removal and de-icing measures are also criti-
cal, and often insufficient or delayed currently in Poland [9].
We recognize and applaud current initiatives being imple-
mented in Poland, which include reduction of the number
of faulty, old cars on the roads by increasing automobile tax

W.Pawłowski et al.
1 3
and insurance rates for older cars in Poland. We also support
ongoing efforts to improve road infrastructure in Poland.
Limitations ofthepresent study
The present study has several strengths, including presen-
tation of analytic results on road traffic injuries in Poland
that have not been previously published, exploration of risk
factors for road traffic injuries in Poland, and identification
of substantial disparities in traffic injury risk in Poland. The
findings of the study offer implications that can contribute
to future development of traffic safety in Poland.
Despite these strengths, there are also limitations. First,
this is a retrospective study, relying on publically available
secondary databases and sources. As with all retrospective
studies, our analyses were restricted to variables that were
collected for purposes that may differ from the primary goals
of the present paper. Second, findings of this study are based
on data provided by selected Poland government datasets,
and may not accurately capture all aspects of road traffic
injuries occurring in Poland. In particular, some injuries
may go unreported by authorities. This is most likely for
less severe injuries, which may be treated on an outpatient
basis and not recorded in hospitals or medical centers. There
is also some possibility that motorists fail to report a crash
to the police out of fear for negative consequences. Third,
the findings and implications of the present study may not
be applicable to road injuries in countries beyond Poland.
Although the human behavioural factors in traffic injuries
might be shared with other populations, caution should be
taken in generalising the findings of the study to other cul-
tures where road infrastructure and regulations might differ.
Author contributions Conceived and designed the experiments: WP,
KG; analysed the data: KG, MG; contributed materials/analysis tools:
MG; wrote and critically edited the paper: WP, KG, MG, DCS, JS.
Compliance with ethical standards
Conflict of interest Witold Pawłowski, Krzysztof Goniewicz, David C.
Schwebel, Jiabin Shen, and Mariusz Goniewicz declare that they have
no conflict of interest.
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